Our results of segment transport treatment in lower extremity long bone defects

Objective: The treatment of defects in long bones resulting from trauma, tumors, gunshot injuries, or osteomyelitis remains challenging and arduous. Although various approaches are used in the treatment of bone defects, our study presents the clinical and radiological outcomes of patients treated with segmental transport following resection of lower extremity long bone defects. Materials and Methods: Between January 2012 and March 2023, patients with lower extremity long bone defects due to osteomyelitis, tumors, trauma, or gunshot injuries were treated with resection and segmental transport at Inonu University Turgut Ozal Medical Center's Orthopedics and Traumatology Clinic. Ilizarov, LRS alone, and magnetically controlled nails combined with LRS were utilized in these treatments. The treatment duration, complications, and functional and radiological outcomes were assessed. Results: Of the 36 patients who completed follow-up, 9 (25%) were female, and 27 (75%) were male, with an average age of 32.5 years (range 12–69 years). The mean defect size was 10.3 cm (range 2.5–20.4 cm), and the average healing time was 12.4 months (range 2–48 months). The mean external fixation duration was 16.9 months (range 3–68 months). The patients' EFI averaged 1.73 months/cm, while the CI averaged 1.41 months/cm. Complications were classified using Paley's complication grading system: 32 issues, 46 obstacles, 12 minor complications, and 28 major complications. Outcomes were evaluated according to the ASAMI bone and functional scores, the Karlström-Olerud functional scale, and the LEFS functional scale. ASAMI bone scoring results were excellent in 15 patients (41.6%), good in 12 (33.3%), fair in 7 (19.4%), and poor in 2 (5.5%). ASAMI functional scoring yielded excellent results in 8 patients (22.2%), good in 20 (55.5%), fair in 4 (11.1%), and poor in 4 (11.1%). According to the Karlström-Olerud functional outcomes, 8 patients (22.2%) had excellent results, 12 (33.3%) had good results, 8 (22.2%) had satisfactory results, and 7 (19.4%) had poor results. LEFS functional scores indicated normal function in 3 patients (8.3%), mild functional loss in 25 (69.4%), moderate functional loss in 6 (16.6%), and severe functional loss in 1 (2.7%). Due to a below-knee amputation following osteomyelitis in 1 patient (2.7%), the treatment was considered unsuccessful in that case. vii Conclusion: Despite the high complication rate and prolonged treatment duration, segmental transport remains a highly effective treatment method for long bone defects in the lower extremities. Keywords: Long bone, bone defect, segment transport, bone lengthening, distraction osteogenesis